Cécile Viboud

Risk factors for acute generalized exanthematous pustulosis (AGEP)—results of a multinational case–control study (EuroSCAR)

Backgroundu2002 Acute generalized exanthematous pustulosis (AGEP) is a disease characterized by the rapid occurrence of many sterile, nonfollicular pustules usually arising on an oedematous erythema often accompanied by leucocytosis and fever. It is usually attributed to drugs.

Association of influenza epidemics with global climate variability

The reasons for the seasonality and annual changes in the impact of influenza epidemics remain poorly understood. We investigated the covariations between a major component of climate, namely the El Niño Southern Oscillation (ENSO), and indicators of the impact of influenza, as measured by morbidity, excess mortality and viral subtypes collected in France during the period 1971–2002. We show that both the circulating subtype and the magnitude of ENSO are associated with the impact of influenza epidemics. Recognition of this association could lead to better understanding of the mechanisms of emergence of influenza epidemics.

Modelling responses to a smallpox epidemic taking into account uncertainty

Epidemiology and modelling are currently under pressure to build consistent scenarios of control in case of deliberate release of biological weapons. In order to assess the key parameters for the control of a smallpox outbreak in a large city (2 million inhabitants), we built a stochastic model to simulate the course of an epidemic controlled by ring vaccination and case isolation. Assuming a reference scenario with 100 index cases and implementation of intervention 25 days after the attack, the model forecasts an epidemic of 730 cases with an epidemic duration of 240 days. Setting intervention 20 days later would result in an almost fourfold increase in the epidemic size. A multivariate sensitivity analysis has selected three key parameters: the basic reproduction number (i.e. the number of secondary cases infected by one case in an entirely susceptible population, equal to 3 in the reference scenario), time to intervention, and proportion of traced and vaccinated contacts.

Decline in HCV testing and compliance with guidelines in patients of Sentinelles general practitioners, 1996–2002

Between 1996 and 2002, the French Sentinelles Network observed a more than 2-fold decline in the annual rate of hepatitis C virus (HCV) screening tests prescribed by general practitioners. During this period it droped from 1080 to 450 per␣100,000 inhabitants. The proportion of HCV-positives increased from 9.7% to 12.9% between 1996 and 1998 but declined steadily afterwards, reaching 7% in 2002. The majority of HCV-positive patients were men (57%), 38% were aged 30–39xa0years and 45% were injecting drug users. Two French guidelines for HCV screening were issued in 1997 and 2001. Of the 3462 patients with a known HCV test result, 27.4% were offered following the 1997 guidelines, among which 23.7% were HCV-positive. Of the same 3462 patients, 36.8% were offered following the extended definition of the risk group in the 2001 guidelines, among which 19.9% were positive. The percentage of subjects tested with no biological sign or clinical symptom and no HCV risk factor varies from 11% to 26% showing that SGPs carry out a targeted screening even if they deviate from the strict recommendations. Of the HCV-positive patients, 14% did not meet any criteria of the guidelines suggesting a lack of sensitivity in the current definition of patients recommended for testing.